Provider Demographics
NPI:1689636516
Name:CARR, JEFF M (PT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:CARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20715 E OCOTILLO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-6118
Mailing Address - Country:US
Mailing Address - Phone:480-888-1558
Mailing Address - Fax:480-888-1533
Practice Address - Street 1:20715 E OCOTILLO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-6118
Practice Address - Country:US
Practice Address - Phone:480-888-1558
Practice Address - Fax:480-888-1533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69007Medicare ID - Type Unspecified